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Research Progress of the Pediatric Cardiology

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A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Cardiology".

Deadline for manuscript submissions: closed (20 September 2022) | Viewed by 21529

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Special Issue Editor

Dr. Massimo Mapelli

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Guest Editor

1. Cardiology Center Monzino, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), 20138 Milano, Italy
2. Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20122 Milan, Italy
Interests: cardiologist; heart failure; exercise
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

I am honored to have been asked to serve as a guest editor for the new Special Issue of Children entitled “Research Progress in Pediatric Cardiology”.

The aim of this Special Issue is to produce a rich collection of research, articles, and opinions for clinicians, academics, and policy makers in the field of Pediatric Cardiology. Contributions involving all aspects of this topic and, in particular, the understanding, management, and improvement of cardiovascular diseases in children will be welcomed.

Our work will be based on an interdisciplinary approach to disseminate advanced knowledge and evidence with the aim to improve pediatric cardiovascular care. High-quality papers in all areas of pediatric cardiology will be handled through a fair and rigorous peer review process.

Innovative papers on new cardiovascular treatments, prognostic indicators, and imaging techniques, as well as studies focused on the impact of disruptive events (i.e., the COVID-19 pandemic), are particularly welcomed. Finally, we also encourage papers focused on cardiovascular diseases in specific populations, such as, for example, low-income countries in which pediatric care is seriously impacted by the overall situation.

I look forward to receiving your contributions.

Dr. Massimo Mapelli
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

pediatric cardiology
congenital heart disease
heart failure
myocarditis
COVID-19 and cardiovascular system
heart transplantation
cardiac imaging in children
pediatric cardiology in low-income countries
rheumatic heart disease
child/children
adolescent
online

Published Papers (10 papers)

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Research

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12 pages, 281 KiB

Open AccessArticle

The Effect of Pythagorean Self-Awareness on Heart Rate Variability, Perceived Stress and Behavior of Preschool Children

by Kyriaki Angelopoulou, Eleni Zaverdinou, Flora Bacopoulou, George P. Chrousos, Giorgos Giannakakis, Christina Kanaka-Gantenbein, Sophie Mavrogeni, Maria Charalampopoulou, Maria Katimertzi and Christina Darviri

Children 2022, 9(10), 1529; https://0-doi-org.brum.beds.ac.uk/10.3390/children9101529 - 06 Oct 2022

Cited by 2 | Viewed by 1702

Abstract

Stress is associated with unhealthy habits and non-communicable diseases. It is also linked to communicable diseases due to its impact on immune function. These can be prevented through intervention programs in schools. The aim of this study was to examine the effect of the simplified Pythagorean Self-Awareness Intervention on heart rate variability (HRV) parameters, perceived stress and behaviors of preschool children. The sample of the study consisted of 45 preschool students. A “one group (double) pretest—posttest design” was used, to allow for comparisons of the measurements before and after the intervention. Students were assessed via two questionnaires (“Perceived Stress Scale for Children” (PSS-C) and “Checklist for Screening Behavioral Problems in Preschool Children”) and a photoplethysmographic (PPG) device. The intervention lasted 9 weeks and included practicing of the Pythagorean Self-awareness techniques and the adoption of healthy behaviors. The results showed no statistically significant differences between the two pretests (p > 0.05 for all comparisons) and statistically significant differences between the second pretest and posttest (“Perceived Stress Scale for Children”, (PSS-C) p < 0.0001, “Checklist for Screening Behavioral Problems in Preschool Children” p < 0.0001 and two indices of PPG device: heart rate mean, p < 0.0001, low frequency/very low frequency, p = 0.034). In conclusion, the Pythagorean Self-Awareness Intervention had a beneficial effect on the sample of preschool students examined, as the results showed an improvement in the perceived stress and the HRV parameters tested, and in engaging healthier behaviors, findings that indicate a relaxed psychologic state and a healthier lifestyle. Full article

(This article belongs to the Special Issue Research Progress of the Pediatric Cardiology)

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11 pages, 1285 KiB

Open AccessArticle

MicroRNA-126-3p/5p and Aortic Stiffness in Patients with Turner Syndrome

by Masood Abu-Halima, Felix Sebastian Oberhoffer, Viktoria Wagner, Mohamed Abd El Rahman, Anna-Maria Jung, Michael Zemlin, Tilman R. Rohrer, Eckart Meese and Hashim Abdul-Khaliq

Children 2022, 9(8), 1109; https://0-doi-org.brum.beds.ac.uk/10.3390/children9081109 - 23 Jul 2022

Cited by 4 | Viewed by 1645

Abstract

Background: Turner Syndrome (TS) is a relatively rare X-chromosomal disease with increased cardiovascular morbidity and mortality. This study aimed to identify whether the circulating miR-126-3p/5p are involved in the pathophysiology of vascular dysfunction in TS. Methods: Using the RT-qPCR, the abundance levels of miR-126-3p and miR-126-5p were determined in 33 TS patients and 33 age-matched healthy volunteers (HVs). Vascular screening, including the assessment of blood pressure, pulse wave velocity, augmentation index, aortic deformation, arterial distensibility, and arterial elastance, was conducted in TS patients and HVs. Results: The abundance levels of miR-126-3p and miR-126-5p were significantly higher in TS patients compared to HVs (p < 0.0001). Within the TS cohort, miR-126-3p/5p correlated significantly with aortic deformation (r = 0.47, p = 0.01; r = 0.48, p < 0.01) and arterial distensibility (r = 0.55, p < 0.01; r = 0.48, p < 0.01). In addition, a significant negative correlation was demonstrated between miR-126-3p and arterial elastance (r = −0.48, p = 0.01). The receiver operating characteristic analysis showed that miR-126-3p and miR-126-5p separated the tested groups with high sensitivity and specificity. Conclusions: The abundance levels of miR-126-3p and miR-126-5p were significantly higher in TS patients compared to HVs. Within the TS cohort, a lower abundance level of miR-126-3p and miR-126-5p was linked with a significantly higher aortic stiffness. Full article

(This article belongs to the Special Issue Research Progress of the Pediatric Cardiology)

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9 pages, 1205 KiB

Open AccessArticle

Clinical Efficacy of Empirical Therapy in Children with Vasovagal Syncope

by Chunyan Tao, Yaxi Cui, Chunyu Zhang, Xueqin Liu, Qingyou Zhang, Ping Liu, Yuli Wang, Junbao Du and Hongfang Jin

Children 2022, 9(7), 1065; https://0-doi-org.brum.beds.ac.uk/10.3390/children9071065 - 17 Jul 2022

Cited by 6 | Viewed by 1769

Abstract

(1) Background: This case-control study was designed to assess the efficacy of empiric treatment for vasovagal syncope in children; (2) Methods: We retrospectively enrolled 181 children with vasovagal syncope from the Department of Pediatrics of Peking University First Hospital. The participants were categorized into four groups, based on the empiric treatment received: conventional treatment, including health education and orthostatic training; conventional treatment plus oral rehydration salts; conventional treatment plus metoprolol; conventional treatment plus midodrine hydrochloride. Patients were followed up to evaluate the syncopal or presyncopal recurrence. Kaplan–Meier curves were drawn to explore the syncopal or presyncopal recurrence in children, and the differences were compared among the groups using a log-rank test; (3) Results: Among the 181 children with vasovagal syncope, 11 were lost to follow-up. The median time of follow-up was 20 (8, 42) months. The Kaplan–Meier survival curve showed no significant difference in syncopal or presyncopal recurrence in children treated with different empiric options according to a log-rank test (χ² = 1.328, p = 0.723); (4) Conclusions: The efficacy of unselected empiric therapy of vasovagal syncope in children was limited, and the individualized therapies merit further studies. Full article

(This article belongs to the Special Issue Research Progress of the Pediatric Cardiology)

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14 pages, 438 KiB

Open AccessArticle

A Selective Screening Strategy Performed in Pre-School Children and Siblings to Detect Familial Hypercholesterolemia

by Alexandra Thajer, Margot Baumgartner, Anselm Jorda, Ulrike Hallwirth, Julia Lischka and Susanne Greber-Platzer

Children 2022, 9(5), 590; https://0-doi-org.brum.beds.ac.uk/10.3390/children9050590 - 21 Apr 2022

Cited by 4 | Viewed by 1715

Abstract

(1) Background: Familial hypercholesterolemia (FH), a most common genetic disorder, is underdiagnosed and untreated, especially in children. Individuals with heterozygous familial hypercholesterolemia mostly present without clinical symptoms and are not informed about their high risk for myocardial infarction. Early diagnosis and treatment can prevent premature atherosclerosis and cardiovascular events in patients with FH. The aim was to evaluate the detection rate of pre-school children with FH at school doctor visits in Vienna and, moreover, to examine the frequency of FH identified in the children’s siblings by this type of screening. (2) Methods: The selective FH- screening was implemented at the school enrolment examinations in the public primary schools of Vienna. The study period included the school years starting in 2017 to 2020. FH was suspected if a questionnaire on hypercholesterolemia, or cardiovascular events in the family history or on the presence of xanthomas or xanthelasma, was positive. Subsequently, lipid testing was performed on pre-school children and their siblings and elevated lipid screening was defined as either positive by LDL-C ≥ 160 mg/dL and/or non-HDL-C ≥ 190 mg/dL or as borderline by LDL-C ≥ 130 mg/dL and/or non-HDL-C ≥ 160 mg/dL. (3) Results: 66,108 pre-school children participated in the school enrolment examination in 868 public elementary schools in Vienna. In 512 (4%) children, the questionnaire caused suspicion of FH. 344 families agreed their participation in the study. Out of 344 (52% male) tested pre-school children, 20 individuals (40% male) had elevated blood lipid levels with a mean LDL-C of 155 ± 29 mg/dL and a non-HDL-C of 180 ± 24 mg/dL. Out of 291 (44% male) tested siblings, 17 individuals (41% male) showed elevated lipids with a mean LDL-C of 144 ± 19 mg/dL, and a non-HDL-C of 174 ± 19 mg/dL. (4) Conclusions: Screening is the key for early diagnosis and treatment of FH. We have implemented a pre-school screening strategy in cooperation with school physicians. We could identify 20 pre-school children and 17 siblings with an elevated lipid screening test. Full implementation of FH-screening in the pre-school examination visits in Vienna would help to detect high-risk children. Full article

(This article belongs to the Special Issue Research Progress of the Pediatric Cardiology)

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10 pages, 1603 KiB

Open AccessArticle

Number of Kawasaki Disease Admissions Is Associated with Number of Domestic COVID-19 and Severe Enterovirus Case Numbers in Taiwan

by Mindy Ming-Huey Guo, Kuender D. Yang, Shih-Feng Liu and Ho-Chang Kuo

Children 2022, 9(2), 149; https://0-doi-org.brum.beds.ac.uk/10.3390/children9020149 - 24 Jan 2022

Cited by 4 | Viewed by 2170

Abstract

Background: Non-pharmaceutical interventions (NPIs) introduced in response to the COVID-19 pandemic, including mask-wearing and social distancing, have changed the prevalence of circulating viruses in the community. Since viral infections represent a potential triggering factor for the development of Kawasaki disease (KD), we examined the relationship between KD admission rates and the number of COVID-19, severe influenza, and severe enterovirus infections both before and after the COVID-19 pandemic. Methods: We conducted a retrospective study using data obtained from the Chang Gung Research Database (including seven Taiwanese hospitals and more than 10,000 beds) and the Centers for Disease Control in Taiwan from January 2018 to December 2020. We recorded the number of KD admissions, as well as COVID-19, severe influenza, and severe enterovirus infections. Results: The numbers of KD admissions, severe enterovirus infections, and severe influenza infections were significantly lower from April to September 2020. The number of KD hospitalizations was positively correlated with the number of domestic COVID-19 cases (p = 0.001). A decrease in KD admission numbers was positively correlated with a decrease in severe enterovirus case numbers (p = 0.007). Conclusion: Our findings provide further evidence that viral infections may be an important trigger factor in the development of KD. Therefore, NPIs may not only prevent transmissible viral infections in children, but also decrease the risk of KD. Full article

(This article belongs to the Special Issue Research Progress of the Pediatric Cardiology)

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10 pages, 568 KiB

Open AccessArticle

Does Oxygen Content Play a Role in Spontaneous Closure of Perimembranous Ventricular Septal Defects?

by Pier Paolo Bassareo, Giuseppe Calcaterra, Martino Deidda, Andrea Raffaele Marras and Giuseppe Mercuro

Children 2021, 8(10), 881; https://0-doi-org.brum.beds.ac.uk/10.3390/children8100881 - 02 Oct 2021

Cited by 2 | Viewed by 1583

Abstract

(1) Background: the impact of a series of laboratory parameters (haemoglobin, haematocrit, foetal haemoglobin, peripheral oxygen saturation, iron, transferrin, ferritin, and albumin) on perimembranous ventricular septal defects spontaneous healing was tested. (2) Methods: one hundred and seven patients were enrolled in the study (57% males; mean age 2.1 ± 0.4 years) and were subsequently subdivided into two groups: self-healing (n = 36) and in need of intervention (n = 71). Self-healing subjects were defined on the basis of an absence of residual shunts at colorDoppler across the previous defect. (3) Results: no statistically significant differences were reported in the size of perimembranous ventricular septal defects between the two groups (p = ns). Conversely, prevalence of anaemia was significantly higher in those requiring intervention than in the self-healing group (p < 0.03), while haemoglobin, iron, ferritin, and albumin levels were lower (p < 0.001, p < 0.05, p < 0.02, p < 0.007, respectively). In multivariable linear regression analysis, only haemoglobin and albumin were found to be associated with spontaneous closure (p < 0.005 and p < 0.02, respectively). In multiple logistic regression analysis, haemoglobin independently increased the probability of self-healing of perimembranous ventricular septal defects (p = 0.03). All patients needing an interventional closure of perimembranous ventricular septal defects presented with haemoglobin <12.7 g/dL. (4) Conclusion: the self-resolution of perimembranous ventricular septal defects seems to rely on numerous factors, including oxygen content, which is likely to promote cell proliferation as well as tissue regeneration. Haemoglobin blood concentration seems to influence the natural history of perimembranous ventricular septal defects and improvement of anaemia by supplementation of iron intake might represent a simple and reliable method to promote self-healing. Full article

(This article belongs to the Special Issue Research Progress of the Pediatric Cardiology)

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Review

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20 pages, 6433 KiB

Open AccessFeature PaperEditor’s ChoiceReview

Role of Cardiovascular Imaging in the Follow-Up of Patients with Fontan Circulation

by Sara Moscatelli, Nunzia Borrelli, Jolanda Sabatino, Isabella Leo, Martina Avesani, Claudia Montanaro and Giovanni Di Salvo

Children 2022, 9(12), 1875; https://0-doi-org.brum.beds.ac.uk/10.3390/children9121875 - 30 Nov 2022

Cited by 9 | Viewed by 3026

Abstract

Since its first description in 1971, the Fontan procedure and its modifications have led to a substantial improvement in the survival rates of patients with a variety of types of complex Congenital Heart Disease (CHD) characterised by the presence of a single, dominant ventricle. However, despite the significant improvement of the prognosis over the years, Fontan patients are still exposed to several cardiovascular and systemic complications. It is, therefore, important to fully understand the pitfalls hidden behind a Fontan anatomy and the potential predictors of ventricular failure. Cardiovascular imaging plays a key role in this context, allowing for the early identification of complications with important prognostic implications. Echocardiography remains the first-line imaging modality for serial evaluation of Fontan patients. However, there is a growing role of cardiovascular magnetic resonance and cardiac computed tomography from pre-operative assessment to longitudinal follow-up. The aim of this paper will be to provide a comprehensive overview of the role, strengths, and weaknesses of each imaging modality in the assessment of congenital cardiac conditions palliated with the Fontan procedure. Full article

(This article belongs to the Special Issue Research Progress of the Pediatric Cardiology)

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20 pages, 54903 KiB

Open AccessReview

Double-Inlet Left Ventricle

by P. Syamasundar Rao

Children 2022, 9(9), 1274; https://0-doi-org.brum.beds.ac.uk/10.3390/children9091274 - 24 Aug 2022

Cited by 4 | Viewed by 2415

Abstract

Double-inlet left ventricle (DILV) is most frequent among univentricular atrioventricular connections. In DILV, there is a single functioning ventricle, most commonly with left ventricular structure. This chamber receives both atrioventricular valves and is connected to an outlet chamber with morphologic features of the right ventricle. The great vessels are often transposed, and pulmonary stenosis is seen in two-thirds of patients. The anatomy and pathophysiology can be defined by echo-Doppler studies with a rare need for other imaging studies. The management is mostly related to the nature of associated heart defects and the degree of pathophysiological abnormality. When the infants present initially, treatment to address the hemodynamic issues is undertaken. Subsequently, these babies need staged total cavo-pulmonary connection, i.e., the Fontan procedure which is undertaken in three stages; these stages are described in this review. The existence of inter-stage mortality and post-Fontan complications is recognized and was reviewed. The paper concludes that DILV can be successfully diagnosed with echo-Doppler studies and this heart anomaly can be effectively treated with the currently prevailing medical, catheter interventional, and surgical treatment practices. Full article

(This article belongs to the Special Issue Research Progress of the Pediatric Cardiology)

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Other

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4 pages, 874 KiB

Open AccessCase Report

Unexplained Hypoxemia in School-Age Child: Do Not Forget the Double Superior Vena Cava

by Luca Pecoraro, Enrico Boninsegna, Emilio Simonini, Paolo Francia, Stefano Colopi and Angelo Pietrobelli

Children 2022, 9(9), 1272; https://0-doi-org.brum.beds.ac.uk/10.3390/children9091272 - 24 Aug 2022

Cited by 1 | Viewed by 1140

Abstract

Persistent left superior vena cava (SVC) is a rare congenital malformation of the thoracic venous system. We report a case involving a 7-year-old boy, who was admitted to our CT scanning room because of an incidental discovery of low blood-oxygen levels (90–94% in good health). A persistent left SVC was depicted, with drainage in the left atrium and a resultant right-to-left shunt;right SVC was present, draining to the right atrium. A small bridging vein was depicted. A comprehensive cardiological assessment with echocardiography was performed, but no other anomalies were found. He was successfully treated with a percutaneous endovascular approach and vascular plug deployment. A complete occlusion of the left SVC was obtained, with normalization of the oxygen saturation. Persistent left SVC is a rare vascular anomaly, often incidentally detected. Physicians should be aware because it may have significant clinical implications, especially during catheterization procedures or when associated with other cardiac malformations. Full article

(This article belongs to the Special Issue Research Progress of the Pediatric Cardiology)

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6 pages, 716 KiB

Open AccessCase Report

Cor Triatriatum Dexter: Contrast Echocardiography Is Key to the Diagnosis of a Rare but Treatable Cause of Neonatal Persistent Cyanosis

by Irene Picciolli, Gaia Francescato, Anna Maria Colli, Alessia Cappelleri, Alessandra Mayer, Roberto Raschetti, Roberta Di Cosola, Marco Pisaniello, Giuseppe Alberto Annoni, Marco Papa, Mimoza Maldi, Guido Olivieri, Fabio Mosca and Stefano Marianeschi

Children 2022, 9(5), 676; https://0-doi-org.brum.beds.ac.uk/10.3390/children9050676 - 06 May 2022

Cited by 2 | Viewed by 2163

Abstract

Cor triatriatum dexter (CTD) is an extremely uncommon and underreported congenital cardiac anomaly in which the persistence of the embryonic right venous valve separates the right atrium into two chambers with varying degrees of obstruction to antegrade flow and variable degree of right to left shunt at atrial level. Depending on the size of the valves, clinical manifestations vary from absence of symptoms to severe hypoxia, requiring urgent surgical correction. We herein describe the diagnostic difficulties in a case of neonatal CTD, who developed increasingly severe and unresponsive cyanosis, first interpreted as postnatal maladjustment with pulmonary hypertension. The failure to respond to oxygen and pulmonary vasodilators led us to reconsider a different diagnosis. The use of contrast echocardiography improved the diagnostic performance of transthoracic echocardiogram (TTE) and revealed a massive right-to-left shunt secondary to the presence of an atrial membrane that required urgent surgery. Full article

(This article belongs to the Special Issue Research Progress of the Pediatric Cardiology)

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